A series of events and global decisions has thrust Uncorrected Refractive Error (URE), poor vision due to the lack of eye exams and spectacles, onto center stage of the global public health agenda. Many of us have worked toward this for a significant part of our lives, whether in the NGO sector, Government, professional associations or the private sector. As this advocacy success knocks on our door, we must ask the difficult questions: Are we ready to scale up refractive services to the next level and create access for all irrespective of their social standing? Can we protect our children from the looming myopia crisis? And, perhaps most important, what strategies will allow us to achieve all of this?
Various reports including the World Health Organisation (WHO) World report on vision and the Essilor report have provided us with valuable data to understand, develop and monitor refractive services. The WHO report, using a 6/12 cut off for measuring impairment, estimates there are close to 950 million people who are blind or vision impaired due to a lack of correction. Additionally, the Essilor report indicates there are 2.7 billion people who have poor vision and need glasses to function effectively, a large percentage without access to the solution. This report uses a 6/9 cut off. This situation is compounded by the fact that projections indicate by 2050 half of the world’s population will be myopic – or short sighted - due to lifestyle changes in an increasingly digital world. Reversing this trend must be an absolute priority.
Civil society, governments and professional associations have done exceptionally well in elevating URE on the global health agenda and have also developed action-oriented projects. The reality, however, is that many of these projects are vertical projects that are limited in developing a comprehensive approach, are donor dependent, and have failed to achieve the demanded scale. Central to achieving scale is an integrated approach that brings all players in eye care together and also develops inter-sectoral collaboration. We cannot talk about systems change and solely encourage non profits to donate or sell specs to under-resourced communities. We must develop strategies that bring together government, non profits, social enterprises and the private sector. The private sector cannot be seen as just a donor but must be embraced as a role player as well. Conflicts of interest should be managed rather than seen as a barrier to entry. Non profits should seriously consider the conflict between their mission and survival. Projects should not only be donor-driven but also scale-driven. This type of approach will demand partnerships both within and outside the sector.
For instance, in 2020, a partnership between MetLife Foundation and EssilorLuxottica’s social impact fund – Vision for Life™ in Bangladesh, was designed to create sustainable livelihoods and improve access to vision care among rural communities in the country. The partnership will train 1,000 new primary vision care providers by the end of 2022 by accelerating the expansion of the Eye Mitra programme launched in Bangladesh in 2017. This partnership adopted a pooled-funding approach, which demonstrates an innovative philanthropic model whereby two foundations with unique development agendas (vision care and financial health) have come together to scale and accelerate impact during times of need.
Such partnerships should not be based on self-interest but on the need facing countries or communities. Mapping the need, followed by matching the appropriate partners, is critical to success. The definition of partners must also be broadened.
All eye care players must convene and collaborate around an ecosystem solution strategy rather than a project strategy. The overall strategy should then define the commitment that partners can make. Once eyecare partners are in agreement, we must then include government health and education departments, non profits, professional associations, and those private sector partners providing philanthropic and social entrepreneurship/inclusive business support in the planning process.
The next level of partnership is integral to defining URE as a development issue. These partners should include departments of finance, procurement, social development, and others in Government, along with development and non profit organisations focused on the aged, entrepreneurship development, literacy, road safety, at-risk youth and last, but certainly not least, community advocacy groups. This list is not exhaustive, but a local mapping will help identify all key players.
The point here is to think beyond eye care and even beyond health. For example, EssilorLuxottica’s 2.5 NVG program in Kenya established a program called Eye Rafiki (ER) that included training and entrepreneurship development, with trainees ultimately owning their own optical shops in rural areas, providing sustainable affordable eye care services in underserved areas. Concurrently, USAID supported the DREAMS partnership which sought opportunities to empower young women who are at risk of HIV. The ER program has additionally provided slots for some of these young women to train and become Eye Rafikis. The thinking is that elevating people out of poverty and providing them with opportunities to run their own enterprises or jobs will motivate behavior change and reduce the risk of HIV. When the Eye Rafiki program was established, the first level of partnerships/interactions was with government health and regulatory bodies, training institutions in the private sector, and collaboration with eye health facilities. The DREAMS partnership is an example of collaboration with development organisations focused on issues beyond eye care. As this is only one example of possible partnerships, more ideas are currently being explored (e.g. linking optometrists to the Eye Rafikis via telemedicine, working with road safety campaigns and other relevant programs).
In order to truly move the needle on URE to the other end of the spectrum where eye exams and spectacles are available to all, we must bring commitment, innovation, change in attitudes and a comprehensive approach to the table. Scale will only be achieved if strong and principled partnerships are established. Thankfully the foundation for this is very promising. As a sector our rallying call should be PARTNER OR PERISH.
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